NHS and local authority commissioners should play their part in protecting people who live in care homes by working to reduce the risk of abuse, neglect and harm.

What has stood out for us when we've talked to commissioners and providers is that when safeguarding incidents do occur, they are often a consequence of poor practice rather than malicious intent. The impact of poor practice and neglect can be just as significant as intentional abuse and yet it is arguably far easier to prevent.

This is where commissioners can make a difference, by proactively promoting safeguarding and good quality care home provision. They can do this through service specification that promotes personalisation, by developing the local market to provide choice and diversity and by supporting services that are user led and innovative. People will then be able to choose where they want to live rather than simply having to accept what's available.

Practical steps for commissioners

Commissioners should ensure that care homes can demonstrate that the person concerned is kept at the centre of the discussions about safeguarding and that, wherever possible, they remain in control of making their own decisions. All the data available to commissioners should be utilised, for example from Care Quality Commission (CQC) inspections, complaints and local adult safeguarding boards, to ensure quality.

The common safeguarding challenges guide offers practical steps for commissioners and providers to support the prevention of abuse, neglect and harm through good quality and practice standards.

It looks at issues that commonly lead to safeguarding referrals such as poor nutritional care, physical abuse between residents, and the maladministration of medication. Some of the underlying causes are also examined, including the need for adequate staffing levels, good record-keeping and training.

People living in care homes need to be in a strong position to speak out should they have concerns. The best way to achieve this is to empower people, keeping them informed and in control of their lives. This way, they're less likely to be the victims of abuse and better able to report it should it happen.

One suggestion in our guide is to provide advocacy and befriending services for people who have communication difficulties and who may be unable to alert someone about a risk or concern.

Why commissioners?

Of course care homes themselves should take responsibility for good quality and safeguarding and they are subject to regulation by the Care Quality Commission. But the commissioner, in many cases, represents the consumer. The local authority also has a responsibility to safeguard people in their area, in particular those who use the services they commission but also those who fund their own care.

The workforce are also key. Commissioners need to ensure that providers properly support their staff through induction, training and supervision. They should also make sure that procedures are in place to capture feedback from staff and that robust whistleblowing policies are in place so that staff can confidently raise any concerns they have.

Policy, procedures and protocols

In all cases of suspected neglect or harm, local multi-agency policies and procedures should be followed. Local protocols should determine when a concern should be referred through safeguarding procedures, and when it should be dealt in another way, such as by supervision and training.

Commissioners should make use of data from safeguarding referrals so they can work with their partners, including the CQC, to monitor and support services that are of concern. They can then work towards better prevention methods.

Finally, it's important that commissioners do not to duplicate monitoring activity but that they work in partnership with other stakeholders, utilising available data, to ensure quality and safety in safeguarding.